I’ve been wanting to write about what Conduct Disorder is because that is one of the disorders my youngest son has been diagnosed with. However, I don’t know if my problem finding the words is because I don’t agree with the diagnosis or if the material on this diagnosis is truly lacking. It seems like every where I look, every link I click on is pretty much just a carbon copy of each other. It’s not very helpful. I can’t even seem to find a digital copy of what the DSM-V actually has to say about it.
I did find one news article from this month showing that the brain grows and develops differently in males that have Conduct Disorder from those that do not have it. The onset of the disorder also plays a role in how the brain develops as well.
Brains of teens with conduct disorder are different
So once again, genes and environment (nature and nurture) are playing a role here. Why should this even be a surprise? Our genes provide the basic building blocks for our brains but our brains are constantly responding and adjusting to our environment – but they can only do so much with the genes they have. It makes sense to me and it should be a given by now, but we should always abide by the scientific method to be sure.
Hopefully we can stop blaming parents for being the cause. However, this shouldn’t give parents a free pass either because again the brain can learn and adapt with what it has. So it’s up to the parents to teach these children how to cope, learn, and adapt with this disorder.
So what exactly is Conduct Disorder?
I think this link may be the best I can find to the DSM-V diagnostic criteria:
Conduct Disorder DSM-5 312.81 (F91.1), 312.82 (F91.2), and 312.89 (F91.9)
You can read the full article but for the sake of simplicity I will list the diagnostic criteria here.
- Aggressive behavior toward others and animals.
- Frequent physical altercations with others.
- Use of a weapon to harm others.
- Deliberately physically cruel to other people.
- Deliberately physically cruel to animals.
- Involvement in confrontational economic order crime- e.g., mugging.
- Has perpetrated a forcible sex act on another.
- Property destruction by arson.
- Property destruction by other means.
- Has engaged in non-confrontational economic order crime- e.g., breaking and entering.
- Has engaged in non-confrontational retail theft, e.g., shoplifting.
- Disregarded parent’s curfew prior to age 13.
- Has run away from home at least two times.
- Has been truant before age 13.
To get this diagnosis, the individual needs to have at least four of the behaviors present. This link doesn’t state a length of time, but other sources have stated the behaviors have to be present for at least 6 months if not a full year.
Additionally, the criteria must:
- The behaviors cause significant impairment in functioning and
- If the individual over age 18 the criteria for APD is not met.
Now if you ask me, some of the items on the list are a bit redundant, such as “Aggressive behavior toward others and animals” and “Frequent physical altercations with others” and “Deliberately physically cruel to other people”. I mean, if you are “Deliberately physically cruel to other people” wouldn’t that automatically mean that you have “Aggressive behavior toward others and animals” and “Frequent physical altercations with others”? So then you would need just one more item on the list to get this diagnosis. I’m sure there is a reason the specialists set it up this way that I can’t fathom and it’s probably due to how people perceive and describe behavior.
Now don’t get me wrong. Looking at this list, I can see why my 6 year old son got this diagnosis. However look at the end under the heading of “Differential Diagnosis” and you will see that professionals are cautioned to make sure to rule out a variety of disorders that include these behaviors that have to be treated and managed differently than Conduct Disorder. Bipolar Disorder is one of the disorders listed because these behaviors can be caused by mania. In fact, the so-called “Bipolar Rage” is pretty famous for it.
Mania is episodic due to the nature of Bipolar Disorder and needs to be regulated with mood stabilizers (therapy can help too). Conduct Disorder is not episodic and responds well to long-term behavioral therapy (not that it’s easy or a cake walk). Two different diagnoses, same behaviors, but very different treatment plans.
So overwhelming and scary. I am sorry he is having to deal with this. It is sad that a disorder like this can affect the ways others see and judge him. You are courageous to read these symptoms list and to find encouragement at the end of responding well to therapy. Hang in there.
To be completely honest, after going through the process of getting my second son diagnosed with Autism I wasn’t prepared to find so little information and so little recommendation for a treatment plan for Conduct Disorder. I was expecting to sit down, look it up, be given a list of symptoms and a long list of treatment options. I wasn’t expecting to get so little. It just gives me greater appreciation for my parents, knowing how we have many of these disorders and none of these resources were available to them at all. I mean I was born with Bipolar. I was THAT moody kid. Somehow even without those resources they did something right. People can say what they want about my family, I know we are all dysfunctional, but none of us are in prison or hospitalized. Far as I know the worst any of us are addicted to is nicotine and caffeine. So all I can do is take what current medical research has to offer, combine it with what my family has to offer and hope for the best. I really don’t know what else to do.
In this day and age there should be an expert on conduct disorders somewhere. Right? Your son is not the only one with it. I am really amazed at how you are dealing with all of this along with being bipolar. You are an amazing and strong woman. Keep writing, maybe someone will see it dealing with the CD as well.
I believe we are finally in good hands over at the hospital we’re at. There is one doctor at the pediatric wing who has been really great. He’s been willing to actually listen to me and both my boys – my oldest and my youngest. The staff there even helped me get a referral for a neuropsych eval for my youngest just to make extra sure of everything. Hope we get that done soon.
As for the writing, it’s part of the reason I started my blog. My sister and friends said on Facebook that I’ve been sharing so much practical information that somewhere out that is bound to find it helpful. I’ve gotten a bit sidetracked with life events, but I hope to be posting more useful information soon.
I know personally that I run into judgement out there for being Bipolar and a parent once in awhile. It stings. This can be done. It just means people like me have to do it differently from everyone else, not necessarily badly.
Sometimes I wonder what my life would be like if we were all “normal” and I’m always struck with the thought that I would literally have nothing to do compared with what I juggle right now. But then again life has a way of filling up our time and keeping us busy, doesn’t it? It would just be a different kind of busy is all. 😉
I disagree. I think your load surpasses that of many, which I think is a compliment to your love and commitment to your children. I think that is why your extended family has not been into addictions or crime. The Bible says love covers a multitude of sins, and in your family, a multitude of problems. You are not angry and accusatory, but understanding and helpful. I have a friend with seven kids all with different disorders, from social anxiety, dyslexia, bi-polar, Down’s Syndrom and autism. My amazing friend homeschools them all and now 3 of them are through college and have done really well. So hang in there. I am so impressed. Truly.
Sorry I didn’t see this sooner. I hadn’t thought of it that way but it certainly explains a lot!